| Objective: Exploring and discussing the influence factors of functional recovery and mortality in youth patients with basal ganglia area hypertensive intracerebral hemorrhage undergoing ateral fissure approach surgery.Based on the related factors with the prognosis and survival were statistically analyzed,guiding the clinical treatment,with a view to increasing the rate of cure,reduce the mortality rate,and improve the prognosis of patients.Methods: This is a retrospective study about youth patients with basal ganglia area hypertensive intracerebral hemorrhage(HICH)undergoing expend lateral fissure approach surgery,which on the basis of reviewed a number of related document literature,combined with the previous study results and clinical experience.The research including 76 patients with inclusion and exclusion criteria admitted to the department of neurovascular surgery in First Hospital of Jilin University.The following variables for patients functional recovery and mortality were selected: Gender,body mass index,past history(history of hypertension,diabetes mellitus,history of smoking and drinking,history of stroke),preoperative condition(bleeding location,preoperative blood pressure,preoperative GCS score,enlargement of preoperative pupil),imaging data(hematoma volume,whether to break into the ventricular system,middle shift degree),operation time,complication(pulmonary infection),laboratory tests(including: preoperative blood glucose,preoperative white blood cell count).The prognosis judgment standard for the surgical treatment of basal ganglia hypertensive cerebral hemorrhage is 30 days recovery of neurological function in patients,using Glasgow outcome score(GOS),patients were divided into two groups according to the clinical prognosis:(1)good neurological recovery group,the GOS is 4-5,patients were restored to walk;(2)bad neurological recovery group,the GOS is 1-3,patients can not walk or more serious.According to patients’ survived for 30 days to analyze the relationship between risk factors and patient survival.Single factor analysis using x~2 test,in order to analysis the statistically significant between the various factors and the prognosis and survival;The meaningful univariate analysis was used to analysis multivariate correlation with prognosis and survival by multivariate Logistic regression model.Results(1)The influence of gender on the prognosis of patients with good or bad results were not statistically significant(x~2=0.023,P=0.879);The influence of gender on the survival rate was not statistically significant(x~2=0.098,P=0.745).(2)The body mass index on the prognosis in patients with good or bad results were not statistically significant(x~2=2.243,P=0.326);body mass index on the survival rate were not statistically significant(x~2=0.042,P=0.979).(3)The history of hypertension on the prognosis were not statistically significant(x~2=0.035,P=0.851);the history of hypertension on the survival rate was not statistically significant(x~2=1.579,P=0.209).(4)With or without a history of diabetes mellitus in patients on the prognosis results were not statistically significant(x~2=2.125,P=0.145);with or without a history of diabetes mellitus on the survival rate were not statistically significant(x~2=1.547,P=0.597).(5)With or without a history of smoking in patients on the prognosis results were not statistically significant(x~2=0.261,P=0.610);with or without a history of smoking on the survival rate was not statistically significant(x~2=0.004,P=0.951).(6)With or without a history of drinking in patients on the prognosis results were not statistically significant(x~2=0.247,P=0.619);with or without a history of drinking on the survival rate was not statistically significant(x~2=2.245,P=0.134).(7)The influence of stroke history on the prognosis of patients has no statistical significance(x~2=0.891,P=0.345);the influence of stroke history on the survival rate was not statistically significant(x~2=0.276,P=0.599).(8)The influence of bleeding location on the prognosis results were statistically significant(x~2=4.215,P=0.040);The influence of bleeding location on the survival rate was not statistically significant(x~2=0.035,P=0.852).(9)Patients with systolic blood pressure on the prognosis in patients with good or bad results were statistically significant(x~2=11.427,P=0.001);patients with systolic blood pressure on the survival rate were statistically significant(x~2=7.181,P=0.007).(10)Patients with diastolic pressure on the prognosis in patients with good or bad results were not statistically significant(x~2=2.515,P=0.113);patients with diastolic blood pressure on the survival rate were not statistically significant(x~2=0.197,P=0.657).(11)Patients preoperative GCS was 7,the preoperative GCS on the prognosis of the patients results were statistically significant(x~2=17.032,P=0.000);the preoperative GCS on the survival results were statistically significant(x~2=13.612,P=0.001).(12)The preoperative pupillary enlargement on the prognosis in patients with good or bad results were statistically significant(x~2=7.502,P=0.006);preoperative pupillary changes on the survival results were statistically significant(x~2=7.918,P=0.005).(13)The average volume of hematoma was 55.02±43.41 ml,the influence of hematoma volume in patients on the prognosis results were statistically significant(x~2=15.977,P=0.001);the influence of hematoma volume in patients on the survival rate were statistically significant(x~2=9.994,P=0.002).(14)Whether to break into the ventricular system on the prognosis in patients had no statistical significance(x~2=0.520,P=0.471);Whether to break into the ventricular system on the survival rate was not statistically significant(x~2=0.022,P=0.882).(15)The degree of midline shift with an average of 11.18 ±3.10 mm,the influence of the midline shift degree in patients on the prognosis were statistically significant effect(x~2=10.304,P=0.001);the influence of the midline shift degree in patients on the survival rate were not statistically significant(x~2=1.890,P=0.169).16,The time of onset to operation on the prognosis results were not statistically significant(x~2=0.099,P=0.753);time of onset to operation on the survival rate were not statistically significant(x~2=0.668,P=0.414).(17)With or without pulmonary infection on the prognosis results were significant effects(x~2=5.010,P=0.025);with or without pulmonary infection on the survival rate wear not statistical significance(x~2=0.094,P=0.759).(18)The preoperative blood glucose had no statistically significant influence with the prognosis of the patients(x~2=2.793,P=0.095);The preoperative blood glucose had statistically significant influence with survival rate of the patients(x~2=4.220,P=0.040).(19)The preoperative white blood cell count had no statistically significant influence with the prognosis of the patients(x~2=0.723,P=0.395);The preoperative white blood cell count had no statistically significant influence with survival rate of the patients(x~2=0.627,P=0.987).(20)The 7 meaningful factors univariate analysis was used to analysis multivariate correlation with prognosis by multivariate Logistic regression model,the results showed that there are 3 factors had a significant result: Bleeding location(P=0.025,OR=6.447,95% CI: 1.263-32.899),preoperative GCS(P=0.009,OR=46.410,95% CI:2.611-842.795),the systolic blood pressure(P=0.031,OR=7.404,95% CI:1.195-45.853).(21)Multivariate analysis for 5 factors which affect the survival outcomes,the results showed that there are 2 factors had a significant result significant: preoperative GCS(P=0.017,OR=3.221,95% CI:3.221-15.085),the volume of hematoma(P=0.047,OR=3.150,95% CI:0.882-11.250).Conclusions: In univariate analysis,there are 7 factors on in patients with clinically significant,including whether the existence of pulmonary infection,bleeding location,the systolic blood pressure,intracranial hematoma volume and midline shift level,preoperative GCS as well as preoperative pupil enlargement;at the same time,there are 3 factors on survival in patients with clinically significant,including preoperative blood glucose,the systolic blood pressure,intracranial hematoma,preoperative GCS as well as preoperative pupil change.Multivariate analysis found that preoperative GCS of 3-6 patients compared with the preoperative GCS for 7-8 patients,the risk of poor prognosis is increased;the bleeding site is located on the left side of the patients compared with bleeding site located on the right side of the patient,the risk of adverse outcomes increased;preoperative systolic blood pressure greater than 200 mm Hg patients compared with preoperative systolic blood pressure less than 200 mm Hg patients,the risk of poor prognosis is increased.Patients with preoperative GCS score of 3-6 had an increased risk of death compared with preoperative GCS score of 7-8;patients with intracranial hematoma greater than 50 ml had an increased risk of death compared with patients with intracranial hematoma of less than 50 ml. |
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